RESUMO
PURPOSE: To validate the New Zealand Anterior Cruciate Ligament (ACL) Registry's capture rate of revisions by cross-referencing Registry data with reoperations data recorded by the Accident Compensation Corporation (ACC) and identify risk factors for all-cause reoperation. METHODS: Primary ACL reconstructions performed between April 2014 and September 2019 were individually matched on a record-by-record basis between the two databases. The ACC database was used to identify patients who underwent a reoperation with manual review of operation notes to identify whether a revision or other procedure was performed. This was combined with the number of revisions separately recorded in the New Zealand ACL Registry, which was used as the denominator value to calculate the Registry's capture rate of revisions. Patient and surgical data recorded in the Registry were analysed to identify independent predictors for all-cause reoperation. RESULTS: A total of 8046 primary ACL reconstructions were matched between the New Zealand ACL Registry and the ACC databases. The reoperation rate was 8.9% (n = 715) at a mean follow-up of 2.5 years. Meniscal-related procedures were the most common reoperation (n = 299, 3.7%), followed by revision ACL reconstruction (n = 219, 2.7%), arthrofibrosis (n = 185, 2.3%), cartilage (n = 56, 0.7%) and implants (n = 32, 0.4%). The New Zealand ACL Registry captured 96% of revisions. Younger age (hazard ratio [HR] > 1.4, p < 0.001), earlier surgery (HR > 1.3, p = 0.05), concurrent meniscal repair (medial meniscus HR = 1.9, p < 0.001 and lateral meniscus HR = 1.3, p = 0.022) and hamstring tendon autografts (HR = 1.4, p = 0.001) were associated with a higher risk of reoperation. CONCLUSION: The New Zealand ACL Registry captured 96% of revisions. Risk factors for all-cause reoperation included younger age, earlier surgery, meniscal repair and hamstring tendon autografts. LEVEL OF EVIDENCE: Level III.
RESUMO
PURPOSE: The purpose of this study is to identify the rate and risk factors for a reoperation for arthrofibrosis following primary anterior cruciate ligament (ACL) reconstruction. METHODS: Prospective data recorded in the New Zealand ACL Registry were cross-referenced with data from the Accident Compensation Corporation (ACC). Primary ACL reconstructions performed between April 2014 and May 2021 were analysed. The ACC database was used to identify patients who underwent a reoperation for a diagnosis of arthrofibrosis. Multivariable survival analysis was performed to compute adjusted hazard ratios (aHR) and 95% confidence intervals. RESULTS: A total of 12,296 primary ACL reconstructions were analysed, of which 230 underwent a reoperation for arthrofibrosis (1.9%) at a mean follow-up of 3.6 years. A higher risk of arthrofibrosis was observed in females (aHR = 1.76, p = 0.001), patients with a history of previous knee surgery (aHR = 1.82, p = 0.04) and when a transtibial drilling technique was used (aHR = 1.53, p = 0.03). ACL reconstruction >6 months after injury had the lowest rate of arthrofibrosis (1.3%, aHR = 0.45, p = 0.01). There was no difference in risk between early surgery within 6 weeks versus delayed surgery between 6 weeks and 6 months after injury (2.9% versus 2.1%, aHR = 0.78, not significant). CONCLUSION: Female sex, previous knee surgery and a transtibial drilling technique increased the risk of reoperation for arthrofibrosis. Early surgery within 6 weeks of injury was not associated with an increased risk when compared with surgery between 6 weeks and 6 months after injury. LEVEL OF EVIDENCE: Level III.
Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Artropatias , Humanos , Feminino , Reoperação , Estudos Prospectivos , Fatores de Risco , Cirurgia de Second-Look , Artropatias/cirurgia , Reconstrução do Ligamento Cruzado Anterior/métodos , Lesões do Ligamento Cruzado Anterior/cirurgia , Estudos RetrospectivosRESUMO
BACKGROUND: The bone-patellar tendon-bone (BTB) autograft is associated with difficulty with kneeling after anterior cruciate ligament (ACL) reconstruction; however, it is unclear whether it results in a more painful or symptomatic knee compared with the hamstring tendon autograft. PURPOSE: To identify the rate and risk factors for knee pain and difficulty with kneeling after ACL reconstruction. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: Primary ACL reconstruction procedures prospectively recorded in the New Zealand ACL Registry from April 2014 to May 2021 were analyzed. The Knee injury and Osteoarthritis Outcome Score (KOOS) was used to identify patients reporting consequential knee pain (CKP), defined as a KOOS Pain subscore of ≤72 points, and severe kneeling difficulty (SKD), defined as a self-report of "severe" or "extreme" difficulty with kneeling. Absolute values of the KOOS Pain and Symptoms subscales were also compared. RESULTS: A total of 10,999 patients were analyzed. At 2-year follow-up, 9.3% (420/4492) reported CKP, and 12.0% (537/4471) reported SKD. The most important predictor of CKP at 2-year follow-up was having significant pain before surgery (adjusted odds ratio, 4.10; P < .001). The most important predictor of SKD at 2-year follow-up was the use of a BTB autograft rather than a hamstring tendon autograft (21.3% vs 9.4%, respectively; adjusted odds ratio, 3.12; P < .001). There was no difference between the BTB and hamstring tendon grafts in terms of CKP (9.9% vs 9.2%, respectively; P = .494) or in absolute values of the KOOS Pain (mean, 88.7 vs 89.0, respectively; P = .37) and KOOS Symptoms (mean, 82.5 vs 82.1, respectively; P = .49) subscales. CONCLUSION: At 2-year follow-up after primary ACL reconstruction, 9.3% of patients reported CKP, and 12.0% reported SKD. The BTB autograft was associated with difficulty with kneeling, but it did not result in a more painful or symptomatic knee compared with the hamstring tendon autograft.
Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Tendões dos Músculos Isquiotibiais , Ligamento Patelar , Humanos , Ligamento Patelar/cirurgia , Autoenxertos/cirurgia , Tendões dos Músculos Isquiotibiais/transplante , Estudos de Coortes , Nova Zelândia/epidemiologia , Enxerto Osso-Tendão Patelar-Osso/métodos , Lesões do Ligamento Cruzado Anterior/complicações , Lesões do Ligamento Cruzado Anterior/cirurgia , Reconstrução do Ligamento Cruzado Anterior/métodos , Dor/etiologia , Sistema de RegistrosRESUMO
PURPOSE: This study aimed to identify the risk factors for meniscal repair failure following concurrent primary anterior cruciate ligament (ACL) reconstruction. METHODS: Prospective data recorded by the New Zealand ACL Registry and the Accident Compensation Corporation were reviewed. Meniscal repairs performed during concurrent primary ACL reconstruction were included. Repair failure was defined as a subsequent reoperation involving meniscectomy of the repaired meniscus. Multivariate survival analysis was performed to identify the risk factors for failure. RESULTS: A total of 3,024 meniscal repairs were analysed with an overall failure rate of 6.6% (n = 201) at a mean follow-up of 2.9 years (SD 1.5). The risk of medial meniscal repair failure was higher with hamstring tendon autografts (adjusted HR [aHR] = 2.20, 95% CI 1.36-3.56, p = 0.001), patients aged 21-30 years (aHR = 1.60, 95% CI 1.30-2.48, p = 0.037) and in patients with cartilage injury in the medial compartment (aHR = 1.75, 95% CI 1.23-2.48, p = 0.002). The risk of lateral meniscal repair failure was higher in patients aged ≤ 20 years (aHR = 2.79, 95% CI 1.17-6.67, p = 0.021), when the procedure was performed by a low case volume surgeon (aHR = 1.84, 95% CI 1.08-3.13, p = 0.026) and when a transtibial technique was used to drill the femoral graft tunnel (aHR = 2.30, 95% CI 1.03-5.15, p = 0.042). CONCLUSION: The use of a hamstring tendon autograft, younger age and the presence of medial compartment cartilage injury are risk factors for medial meniscal repair failure, whereas younger age, low surgeon volume and a transtibial drilling technique are risk factors for lateral meniscal repair failure. LEVEL OF EVIDENCE: Level II.
Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Humanos , Lesões do Ligamento Cruzado Anterior/cirurgia , Lesões do Ligamento Cruzado Anterior/etiologia , Estudos Prospectivos , Nova Zelândia/epidemiologia , Reconstrução do Ligamento Cruzado Anterior/métodos , Sistema de Registros , Meniscos Tibiais/cirurgia , Estudos RetrospectivosRESUMO
BACKGROUND: Young female athletes are a specific population that is at high risk of primary anterior cruciate ligament (ACL) rupture and subsequent graft failure. Despite large numbers of ACL reconstructions being carried out in young women, there is limited analysis of outcomes in this group, leading to low levels of evidence for graft choice. PURPOSE: To assess the effect of graft choice on ACL reconstruction failure rates among young women in New Zealand. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: Prospective data captured by the New Zealand ACL Registry between April 2014 and March 2022 were reviewed. Young women aged 15 to 20 years were included. The primary outcome measure was ACL graft failure during the study period, with the key independent variable being graft type, either patellar or hamstring tendon autograft. This is presented as the rate per 100 patient-years and is compared between the 2 groups using the hazard ratio generated from a Cox proportional hazards regression. Secondary outcome measures were Marx activity scores and the Knee injury and Osteoarthritis and Outcome Score patient-reported outcome measure. RESULTS: A total of 1261 primary ACL reconstructions in young women aged 15 to 20 years were reviewed. Hamstring tendon grafts were used in 797 (63%) reconstructions and patellar tendon graft in 464 (37%) reconstructions. Patients with a hamstring tendon graft had a graft failure rate of 7.7% compared with 1.1% in patients with a patellar tendon graft (hazard ratio, 6.1; 95% CI, 2.4-15.1; P < .001). The number of failures per 100 person-years was significantly higher in the hamstring group (2.05) compared with the patellar tendon group (0.37). No difference was noted at final follow-up between the hamstring tendon and patellar tendon groups when comparing patient-reported outcome measures during the follow-up period. CONCLUSION: In the young female population of this study, the use of a patellar tendon graft was associated with reduced risk of graft failure and was not associated with an increase in knee morbidity. This highlights the importance of informed decision-making in this high-risk population when considering ACL reconstruction graft type.
Assuntos
Lesões do Ligamento Cruzado Anterior , Tendões dos Músculos Isquiotibiais , Ligamento Patelar , Humanos , Feminino , Ligamento Patelar/cirurgia , Estudos de Coortes , Estudos Prospectivos , Nova Zelândia , Lesões do Ligamento Cruzado Anterior/cirurgia , Transplante Autólogo , Tendões dos Músculos Isquiotibiais/transplante , Sistema de RegistrosRESUMO
BACKGROUND: The hamstring tendon is frequently used to reconstruct the anterior cruciate ligament (ACL), but there is a lack of consensus on the optimal method of fixation. Registry studies have shown that the type of femoral fixation device can influence the risk of revision ACL reconstruction (ACLR), but it is unclear whether the type of tibial fixation has an effect. In New Zealand, over 95% of hamstring tendon grafts are fixed with an adjustable loop suspensory device on the femoral side, with variable usage between suspensory and interference devices, with or without a sheath, on the tibial side. PURPOSE: To investigate the association between the type of tibial fixation device and the risk of revision ACLR. STUDY DESIGN: Cohort Study; Level of evidence, 2. METHODS: Prospective data recorded in the New Zealand ACL Registry were analyzed. Only primary ACLRs performed with a hamstring tendon autograft fixed with a suspensory device on the femoral side were included. A Cox regression survival analysis with adjustment for patient factors was performed to analyze the effects of the type of tibial fixation device, the number of graft strands, and graft diameter on the risk of revision. RESULTS: A total of 6145 primary ACLRs performed between 2014 and 2019 were analyzed. A total of 59.6% of hamstring tendon autografts were fixed with a suspensory device on the tibial side (n = 3662), 17.6% with an interference screw with a sheath (n = 1079), and 22.8% with an interference screw without a sheath (n = 1404). When compared with suspensory devices, a higher revision risk was observed when using an interference screw with a sheath (adjusted hazard ratio [HR], 2.05; P = .009) and without a sheath (adjusted HR, 1.81; P = .044). The number of graft strands and a graft diameter of ≥8 mm were associated with the rate of revision on the univariate analysis; however, after adjusting for confounding variables on the multivariate analysis, they did not significantly influence the risk of revision. CONCLUSION: In this study of hamstring tendon autografts fixed with an adjustable loop suspensory device on the femoral side during primary ACLR, the use of an interference screw, with or without a sheath, on the tibial side resulted in a higher revision rate when compared with a suspensory device.
Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Tendões dos Músculos Isquiotibiais , Ligamento Cruzado Anterior/cirurgia , Lesões do Ligamento Cruzado Anterior/cirurgia , Reconstrução do Ligamento Cruzado Anterior/métodos , Autoenxertos/cirurgia , Estudos de Coortes , Tendões dos Músculos Isquiotibiais/transplante , Humanos , Nova Zelândia , Estudos Prospectivos , Sistema de RegistrosRESUMO
BACKGROUND: In primary anterior cruciate ligament (ACL) reconstruction, a bone-patellar tendon-bone (BTB) autograft is associated with lower ipsilateral failure rates. BTB autografts are associated with a higher rate of contralateral ACL injuries, which some clinicians view as a marker of success of the BTB autograft. However, there is a lack of evidence on whether BTB autografts improve the rate of return to activity and sport. PURPOSE: To compare the rate of return to preinjury activity levels in high-activity patients after ACL reconstruction with BTB autograft or hamstring tendon autograft. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: In a high-activity cohort of patients recorded between 2014 and 2018 in the New Zealand ACL Registry, prospectively collected data on preinjury and postoperative Marx activity scores were analyzed. The proportion of patients who returned to their preinjury activity levels at 1- and 2-year follow-up was compared between graft types. RESULTS: Overall, 11.3% (208/1844) of patients returned to their preinjury activity levels at 1-year follow-up, and 15.5% (184/1190) returned at 2-year follow-up. At 1-year follow-up, 17.2% of patients with a BTB autograft returned to their preinjury activity levels compared with 9.3% of patients with a hamstring tendon autograft (adjusted odds ratio, 1.59 [95% CI, 1.16-2.17]; P = .004). At 2-year follow-up, 23.3% of patients with a BTB autograft had returned to their preinjury activity levels compared with 13.3% of patients with a hamstring tendon autograft (adjusted odds ratio, 1.63 [95% CI, 1.14-2.34]; P = .008). Male sex and younger age were associated with a higher rate of return to activity at both follow-up time points. CONCLUSION: The use of BTB autografts increased the odds of returning to preinjury activity levels at early follow-up. A higher rate of return to activity is a possible explanation for the higher rate of contralateral ACL injuries with the use of BTB autografts.
Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Tendões dos Músculos Isquiotibiais , Ligamento Patelar , Lesões do Ligamento Cruzado Anterior/cirurgia , Autoenxertos , Estudos de Coortes , Humanos , Masculino , Nova Zelândia/epidemiologia , Sistema de Registros , Transplante AutólogoRESUMO
PURPOSE: The use of an accessory anteromedial portal to drill the femoral graft tunnel in primary anterior cruciate ligament (ACL) reconstruction was introduced in the 2000s in an effort to achieve a more anatomic femoral tunnel position. However, some early studies reported an increase in revision ACL reconstruction compared to the traditional transtibial technique. The aim of this study was to analyse recent data recorded by the New Zealand ACL Registry to compare outcomes of ACL reconstruction performed using the anteromedial portal and transtibial techniques. METHODS: Analysis was performed on primary isolated single-bundle ACL reconstructions recorded between 2014 and 2018 by the New Zealand ACL Registry. Patients were categorised into two groups according to whether an anteromedial portal or transtibial technique was used to drill the femoral graft tunnel. The primary outcome was revision ACL reconstruction and was compared between both groups through univariate and multivariate survival analyses. The secondary outcomes that were analysed included subscales of the Knee Injury and Osteoarthritis Outcome Score (KOOS) and Marx activity score. RESULTS: Six thousand one hundred and eighty-eight primary single-bundle ACL reconstructions were performed using either the anteromedial portal or transtibial drilling techniques. The mean time of follow-up was 23.3 (SD ± 14.0) months. Similar patient characteristics such as mean age (29 years, SD ± 11), sex (males = 58% versus 57%) and time to surgery (median 4 months, IQR 5) were observed between both groups. The rate of revision ACL reconstruction was 2.6% in the anteromedial portal group and 2.2% in the transtibial group (n.s.). The adjusted risk of revision ACL reconstruction was 1.07 (95% CI 0.62-1.84, n.s.). Patients in the anteromedial portal group reported improved scores for subscales of the KOOS and higher Marx activity scores at 1-year post-reconstruction. CONCLUSION: There was no difference in the risk of revision ACL reconstruction between the two femoral tunnel drilling techniques at short-term follow-up. We observed minor differences in patient-reported outcomes at 1-year follow-up favouring the anteromedial portal technique, which may not be clinically relevant. Surgeons can achieve good clinical outcomes with either drilling technique. LEVEL OF EVIDENCE: III.
Assuntos
Lesões do Ligamento Cruzado Anterior/cirurgia , Reconstrução do Ligamento Cruzado Anterior/estatística & dados numéricos , Fêmur/cirurgia , Sistema de Registros , Reoperação/estatística & dados numéricos , Tíbia/cirurgia , Adolescente , Adulto , Reconstrução do Ligamento Cruzado Anterior/métodos , Feminino , Humanos , Masculino , Nova Zelândia/epidemiologia , Medidas de Resultados Relatados pelo Paciente , Estudos Retrospectivos , Adulto JovemRESUMO
OBJECTIVE: The current research evaluated whether Go/No-go training for highly palatable (HP) food affected attention bias for HP food (an automatic/implicit outcome) and intention to eat unhealthy food (a controlled/explicit outcome). METHOD: A sample of Australian adults representative for age, gender and Body Mass Index (BMI) (N = 561, Mage = 46.31 years, SD = 16.75, 52.3% women, MBMI = 27.11, SD = 6.34) completed self-report measures of dietary psychological constructs and food image modified Stroop tasks as measures of pre- and post-test attention bias for HP food. After random assignment of participants to two conditions, a Go/No-go intervention was used to train HP food targeted inhibitory control in the experimental group, or general inhibitory control in the control group. All research tasks were delivered online. RESULTS: The experimental, HP food inhibitory control training group reported intention to eat less unhealthy food than the control group, F (1, 637) = 4.81, R2 = 0.09, p = .029. Counter to expectations, the experimental group exhibited a heightened attention bias to HP food images after the training, F (1, 637) = 9.48, R2 = 0.39, p = .002. CONCLUSION: Go/No-go training for food may improve both top-down and bottom-up inhibitory control, using both automatic and controlled processes. Further, it may not be effective in lowering attention bias for HP food, but may be effective in lowering unhealthy food intake despite raising attention bias for HP food. Further research that tests these effects using varied reaction time tasks is needed to confirm these results and to explore possible alternative explanations.
Assuntos
Viés de Atenção , Dieta Saudável/psicologia , Comportamento Alimentar/psicologia , Inibição Psicológica , Intenção , Adulto , Austrália , Índice de Massa Corporal , Comportamento de Escolha , Ingestão de Alimentos/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estimulação Luminosa , Tempo de ReaçãoRESUMO
BACKGROUND: To identify the patient and surgical factors associated with revision anterior cruciate ligament (ACL) reconstruction as reported by all national and community ACL registries. METHODS: A systematic review was performed on the MEDLINE, Embase and Cochrane Library databases. Eligibility criteria included English studies published by national or community ACL registries reporting on primary ACL reconstruction and risk factors associated with revision ACL reconstruction. RESULTS: Thirty-three studies from the Swedish, Norwegian, Danish and Kaiser Permanente registries were included for review. Fourteen studies from all four registries reported younger age as a risk factor for revision ACL reconstruction. In addition, the Swedish registry reported concomitant medial collateral ligament (MCL) injury, undergoing earlier surgery, lower Knee Injury and Osteoarthritis Outcome Score (KOOS), smaller graft diameter and an anteromedial portal drilling technique as risk factors for revision. The risk factors reported by the Norwegian registry included lower body mass index (BMI), lower KOOS, hamstring tendon grafts and suspensory fixation. The Danish registry reported hamstring tendon grafts, anteromedial portal drilling and suspensory fixation as risk factors. The Kaiser Permanente registry reported male sex, lower BMI, ethnicity, hamstring tendon grafts, allografts, smaller graft diameter and an anteromedial portal technique as risk factors for revision. CONCLUSION: Multiple patient and surgical factors were associated with increased risk of revision ACL reconstruction in registries. Younger age and the use of hamstring tendon grafts were consistently reported as risk factors for failure.
Assuntos
Lesões do Ligamento Cruzado Anterior/cirurgia , Reconstrução do Ligamento Cruzado Anterior , Feminino , Tendões dos Músculos Isquiotibiais/transplante , Humanos , Masculino , Sistema de Registros , Reoperação , Fatores de RiscoRESUMO
PURPOSE: There remains a lack of consensus on the patient factors associated with graft rupture following anterior cruciate ligament (ACL) reconstruction. This study aimed to identify the rate of revision and surgeon-reported graft rupture and clarify the patient risk factors for failure. METHODS: Analysis was conducted on prospective data captured by the New Zealand ACL registry. All primary isolated ACL reconstructions recorded between April 2014 and December 2018 were reviewed to identify the rate of revision and surgeon-reported graft rupture. Univariate and multivariate survival analysis was performed to identify patient factors associated with revision and graft rupture. RESULTS: A total of 7402 primary isolated ACL reconstructions were reviewed and had a mean follow-up time of 23.1 (SD ± 13.9) months. There were 258 surgeon-reported graft ruptures (3.5%) of which 175 patients underwent subsequent revision ACL reconstruction (2.4%). Patients younger than 18 years had the highest risk of revision (adjusted HR = 7.29, p < 0.001) and graft rupture (adjusted HR = 4.26, p < 0.001) when compared to patients aged over 36 years. Male patients had a higher risk of revision (adjusted HR = 2.00, p < 0.001) and graft rupture (adjusted HR = 1.70, p < 0.001) when compared to their female counterparts. Patients who underwent ACL reconstruction within 6 months of their injury had a two times increased risk of revision compared to patients who had surgery after 12 months (adjusted HR = 2.15, p = 0.016). CONCLUSION: Younger age, male sex and a shorter injury-to-surgery time interval increased the risk of revision, while younger age and male sex increased the risk of surgeon-reported graft rupture. LEVEL OF EVIDENCE: II.
Assuntos
Reconstrução do Ligamento Cruzado Anterior/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Sistema de Registros , Reoperação/estatística & dados numéricos , Ruptura/epidemiologia , Adolescente , Adulto , Lesões do Ligamento Cruzado Anterior/cirurgia , Feminino , Humanos , Masculino , Nova Zelândia/epidemiologia , Estudos Prospectivos , Fatores de Risco , Cirurgiões , Adulto JovemRESUMO
BACKGROUND: The patellar tendon is often considered the "gold standard" graft for reducing the risk of graft rupture after anterior cruciate ligament (ACL) reconstruction. However, its use may also be associated with an increased risk of injury to the contralateral ACL. PURPOSE: To clarify the association between graft choice and the risk of revision and contralateral ACL reconstruction. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: Prospective data captured by the New Zealand ACL Registry between April 2014 and December 2018 were reviewed. All primary ACL reconstructions performed using either a hamstring tendon or patellar tendon autograft were included. Cox regression survival analysis adjusting for patient factors was performed to compare the risk of revision and contralateral ACL reconstruction between the hamstring tendon graft and the patellar tendon graft. RESULTS: A total of 7155 primary ACL reconstructions were reviewed, of which 5563 (77.7%) were performed using a hamstring tendon graft and 1592 (22.3%) were performed using a patellar tendon graft. Patients with a hamstring tendon graft had a revision rate of 2.7% compared with 1.3% in patients with a patellar tendon graft (adjusted hazard ratio [HR], 2.51; 95% CI, 1.55-4.06; P < .001). The patellar tendon graft was associated with an increased risk of contralateral ACL reconstruction compared with the hamstring tendon graft (adjusted HR, 1.91; 95% CI, 1.15-3.16; P = .012). The number needed to treat (NNT) with a patellar tendon graft to prevent 1 revision was 73.6. However, the NNT with a hamstring tendon graft to prevent 1 contralateral reconstruction was 116.3. CONCLUSION: Use of a patellar tendon graft reduced the risk of graft rupture but was associated with an increased risk of injury to the contralateral ACL. Adequate rehabilitation and informed decision making on return to activity and injury prevention measures may be important in preventing subsequent injury to the healthy knee.
Assuntos
Lesões do Ligamento Cruzado Anterior/cirurgia , Reconstrução do Ligamento Cruzado Anterior/estatística & dados numéricos , Tendões dos Músculos Isquiotibiais/transplante , Ligamento Patelar/cirurgia , Procedimentos de Cirurgia Plástica/estatística & dados numéricos , Reoperação/estatística & dados numéricos , Adolescente , Adulto , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nova Zelândia , Ligamento Patelar/lesões , Ligamento Patelar/transplante , Estudos Retrospectivos , Risco , Ruptura/cirurgia , Transplantes/estatística & dados numéricos , Adulto JovemRESUMO
OBJECTIVE: The current research created and validated three new measures of psychological mechanisms associated with dietary behavior: (i) a Dietary Goal-Desire Incongruence scale assessed the degree of conflict between ideal dietary behavior and incongruent tempting desires; (ii) a Motivation for Dietary Self-control scale measured the extent and type of motivation, according to Self-Determination Theory, which may be experienced when trying to control dietary behavior; and (iii) a Satisfaction with Dietary Behavior scale measured successful dietary goal-behavior alignment. METHOD: A representative sample of Australian adults (Nâ¯=â¯448, Mageâ¯=â¯45.7 years, SDâ¯=â¯16.98, 50.2% women) rated items assessing the three target constructs and also completed established scales that measure related and unrelated constructs. RESULTS: Exploratory factor analyses indicated a 1-factor Dietary Goal-Desire Incongruence scale (6 items), 3-factor Motivation for Dietary Self-control scale (11 items), and a 1-factor Satisfaction with Dietary Behavior scale (8 items). Confirmatory factor analyses also supported the model fit of each scale's factor solution. Internal consistency as assessed by Cronbach's alpha (α) was 0.94, 0.78, and 0.94 for the three scales, respectively. A follow-up mediation analysis revealed a stage model of psychological factors related to dietary behavior (as assessed by these three scales) that build on each other. Test-retest reliability was high for each scale (râ¯=â¯.71-.84) and showed sound predictive validity. CONCLUSION: The Dietary Goal-Desire Incongruence scale, Motivation for Dietary Self-control scale, and Satisfaction with Dietary Behavior scale show good psychometric properties and are brief, easy to administer measures. The utility of the scales can be explored further with other populations and in intervention studies.
Assuntos
Dieta/psicologia , Objetivos , Motivação , Autonomia Pessoal , Satisfação Pessoal , Inquéritos e Questionários/normas , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Austrália , Análise Fatorial , Comportamento Alimentar/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Psicometria , Reprodutibilidade dos Testes , Inquéritos e Questionários/estatística & dados numéricos , Adulto JovemRESUMO
Modern attitudes to meat in both men and women reflect a strong meat-masculinity association. Sex differences in the relationship between meat and masculinity have not been previously explored. In the current study we used two IATs (implicit association tasks), a visual search task, and a questionnaire to measure implicit and explicit attitudes toward meat in men and women. Men exhibited stronger implicit associations between meat and healthiness than did women, but both sexes associated meat more strongly with 'healthy' than 'unhealthy' concepts. As 'healthy' was operationalized in the current study using terms such as "virile" and "powerful," this suggests that a meat-strength/power association may mediate the meat-masculinity link readily observed across western cultures. The sex difference was not related to explicit attitudes to meat, nor was it attributable to a variety of other factors, such as a generally more positive disposition toward meat in men than women. Men also exhibited an attention bias toward meats, compared to non-meat foods, while females exhibited more caution when searching for non-meat foods, compared to meat. These biases were not related to implicit attitudes, but did tend to increase with increasing hunger levels. Potential ultimate explanations for these differences, including sex differences in bio-physiological needs and receptivity to social signals are discussed.
RESUMO
BACKGROUND: Surgeons working in orthopedic operating theatres are exposed to significant noise pollution due to the use of powered instruments. This may carry a risk of noise-induced hearing loss. The present study was designed to quantify the noise exposure experienced by surgeons and establish whether this breaches occupational health guidelines for workplace noise exposure. METHODS: A sound dosimeter was worn by the operating surgeon during three total hip replacements and two total knee replacements. A timed record of the procedures was kept concurrently. Noise levels experienced during each part of the procedure and total noise exposures were measured. Noise exposures were compared with occupational health guidelines. RESULTS: Noise exposure in total hip replacement averaged 4.5% (1.52-6.45%) of the allowed daily dose (average duration 77.28 min). Total knee replacement exposure was 5.74% (4.09-7.39%) of allowed daily exposure (average duration: 69.76 min). Maximum sound levels approached but did not exceed recommended limits of 110 dBA (108.3 dBA in total hip replacement and 107.6 dBA in total knee replacement). Transient peak sound levels exceeded maximums of 140 dB on multiple occasions during surgery. CONCLUSIONS: Overall total noise dose during orthopaedic surgery was acceptable but orthopaedic surgeons experience brief periods of noise exposure in excess of legislated guidelines. This constitutes a noise hazard and carries a significant, but unquantified risk for noise-induced hearing loss.